Is there a difference between equity and equality – and does it matter? In this episode, Matthew Taylor puts the question to Miriam González Durántez, esteemed international trade lawyer and passionate advocate of women's rights and the education of girls. In this International Women’s Day special, Miriam gets candid about equal opportunities, diversity on boards and the economics of care. She also shares two simple ways to effect change, how leaders can move beyond lip service to equity, and why she hopes her viral #ThisLittleGirlIsMe campaign will make a lasting difference.
Health on the Line
Our podcast series offers fresh perspectives on the healthcare challenges of our time and ways to confront them. Tune in for interviews with the movers and shakers making waves across health and care
Hello and welcome to the latest Health on the line. Today features a great interview that I had with the international trade lawyer, but campaigner also around women's leadership, Miriam González Durántez. So please stay with us to listen to that really interesting conversation.
Part of the reason why we've chosen this interview with Miriam for today is because, of course, today or the day that I'm recording, this is International Women's Day. The Confederation is proud to be hosting an event of our Health and Care Women's Leaders Network with Amanda Pritchard and hosted by network chair Sam Allen. We've got some fantastic presenters, Sajida Ahmed, Sabina Hafesji, who are the co-chairs, introducing the NHS Muslim Women's Network, and Claire Barnett, executive director of UN Women on the Role of International Women's Day as a day for action, not just celebration.
So, lots of stuff we're doing around international Women's Day. In terms of more generally what's going on. The good news is, as I speak, that negotiations are continuing between the government, employers and trade unions. And we've seen industrial action put on abeyance while those negotiations take place. So, we're still hoping that there'll be a positive outcome to those negotiations, both in terms of this year's pay, but also hopefully next year's pay as well.
But whilst that's the good news, the bad news is that, again, at time of speaking, the junior doctors strike is still likely to be going ahead. And that is extremely worrying to us. Our leaders tell us that there are real issues around patient safety and a major impact on the capacity of providers to meet their key targets, particularly in relation to the recovery of services and the elective backlog.
So, we're very worried about the junior doctors action. We're worried that at the moment there's no agreement in terms of those services that might be covered and potentially no services being covered that will then rely on consultants stepping up. But consultants themselves have voted in positively in an affirmative vote in terms of considering action over pay themselves. And even if consultants do step up, there's concerns that they will ask for the BMA rate card, which means more financial pressure on providers who are already very overstretched.
So, in the context of this really worrying threat of junior doctors strike action, three days, we're calling on both sides, the government and the junior doctors, to try to find a way of bridging what is currently a really big gap between them.
And then a couple of other issues. We have joined a 30-strong coalition of organisations expressing profound concern to the government about the further delay in the publication of the public health grant. We've seen that public health grant cut in real terms year after year, so we really need to see that grant and we need to see a reversal of the process of reducing it, if we have any commitment to actually shifting towards an agenda to focus more on prevention, improvements in population health, then we've got to start recognising the importance of the way in which we fund public health.
And then that takes me to two final issues. We are seeing worrying signs that the government may step away from fully funding the workforce plan that we know has been produced and that is ready for publication. We would be extremely concerned if this happens. As everybody knows, as every leader I speak to tells me, the rate limiting factor in the health service is workforce. We've been calling for this workforce plan for years. We were delighted when it was finally announced. But if we have a plan but not the funding to go with it, it's going to be profoundly disappointing and it's difficult if we don't really grasp these workforce issues to see how the NHS moves away from being in a perpetual state of crisis management.
And then more broadly, money is certainly moving up the agenda. When I talk to systems that are now course facing a 30 per cent cut in their establishment over the next two years, I talk to providers about their financial situation. Money is now becoming a very big and pressing issue. We hear there's no extra money likely to be announced in the budget. So of course, that opens up the question if we are going to have slightly more generous pay settlements for our staff, where is that money going to come from?
So we will be pressing very hard in the next few days, both in terms of revenue and capital for a recognition of the funding that the NHS needs if it's going to carry on doing what we have to do, which is to meet very high levels of demand, presenting themselves in every part of the system and at the same time to recover services to tackle the elective waiting list, but the waiting list that exists in all parts of our service and we're going to need to put the pressure on to have a proper, sustainable long-term plan for both workforce funding and particularly capital funding in the NHS.
That's our day-to-day work and we'll press on with it. But now do please sit back or whatever it is you're doing when you listen to this podcast and listen to my interview with Miriam González Durántez
Well, I'm delighted to be joined for this edition of Health on the Line by Miriam González Durántez. It's fantastic to be speaking to Miriam in a programme which is particularly focussed around International Women's Day.
So, Miriam, welcome. We're delighted to have this conversation with you. For anybody who doesn't know, you're an esteemed international trade lawyer, you're a passionate advocate of women's rights and the education of girls, a published author, and you’ve sat on the board of a number of large banks, multinational companies. You've got, as I say, a long record of a kind of advocacy around women's and girls’ rights.
Before we get into some of the issues I want to explore with you, it would be great if you could just share with us a bit about your own leadership journey.
Well, first of all, thank you so much for having me. I'm a passionate supporter of the NHS and I owe so much to the to the NHS having had a son with cancer. So, I would be grateful forever until I die to the NHS and everybody who makes it work.
My leadership journey. I think that when you ask a question like that directly, the first thing that comes to my mind is: have I really had a leadership journey? And I have never focussed myself on whether what I was doing was leadership or not. What I have done in my life really is just to work hard in my professional life.
And then there has been one area that I have always felt passionate about, which is to make sure that girls have enough female role models so that they can see all the different things that they can do in life. And all that I have done is to provide a framework for women to be able to be there and to be seen by girls. And I suppose that some may see that as leadership. I just see that as a natural development in my life.
And Miriam, for yourself. Have there been times in your journey where being a woman has presented additional kind of challenges.
Many, many times and there continue being many obstacles that come simply from the fact that I am a woman. But I guess that the first main obstacle that I had is that I am a girl who was brought up in Spain in the time, in the transition from dictatorship to democracy, and I was really lucky to be brought up in in an atmosphere, in a culture that valued effort. But I wasn't really educated in risk, girls in my time, you know, they didn't encourage us to take risks and to be able to assess risk and to deal with it. And that is something that I have had to learn later on.
There have been many obstacles, of course, at the time that I was having children and I have three sons and I'm by and large it is still women who deal with bringing up children and certainly dealing with the houses. So, during that time I had additional pressures that I don't think I would have had, generally speaking, I'm generalising, I would not have had if I had been a man. And, you know, throughout my whole journey, I have found plenty of times that that some men mostly, but some women as well, wanted kind of to put me in my place and tell me that I was only doing what I am doing because of being married to a man who was in politics at the time. And I have had to fight against that perception and to make sure that I was putting out there the point that the value of women doesn't depend on who we are married to, who we are daughters of, who, whatever, that it depends on ourselves. So, yes, all that I have had to deal with, as I indeed think that many women have to deal with that and much worse.
Yes. I mean, I remember when you came to kind of public prominence as a consequence of being married to Nick Clegg. I remember at the time there was this kind of process. It was quite quick, but there was this kind of process where the mainstream media went, oh, it turns out that this woman isn't just the wife of a politician. She's quite interesting and it must have been quite annoying for you to have to go through that process of being discovered to be a person in your own right.
Well, I have never taken that too personally. But, I have had moments that I have been very surprised at, not really the public reaction, the reaction of the media, which I think that is much more old fashioned. And it takes much longer to adapt to reality. But I remember vividly, for example, making the headlines and being not just in the tabloids, but being in the Today programme, for example, simply because I said that I share with my husband the taking the children to school every day and that was almost revolutionary. And it's like really, that is that is an issue. Or when I said that I of course I would try to help my husband, but I could not afford to give up two months of my time, of my work just dedicated to him. And all those issues were a surprise. If I had been a man, that would not have been a surprise. So the impact that that has on girls, that is what worries me, is not so much the personal side because I know how to deal with it, but the impact that that has on the next generation, that drip, drip sexism, that is a worry.
So, you launched Inspiring Girls in 2016. And I'm interested in in what prompted you to do that and also particularly what was the kind of theory of change that lay behind that? Why did you think that was the particular type of intervention that you wanted to focus on?
Well, I had started something similar beforehand in 2013 here in the UK, and at the time it was called Inspiring Women. And I got into that for two reasons. On the one hand, I had always, as I said earlier, been preoccupied about the fact that many girls say that they don't have access, they feel they don't have access, to female role models, which I have always thought that is is just bizarre because myself on my own, I know so many, I mean, hundreds of wonderful female role models, women that they are not necessarily on the magazine or on television every day, but they are amazing and all the girls should be looking up to them. And how come we are not exposing those women to girls? And on the other hand, I found myself precisely because of the fact that Nick was in politics and there was media attention on me, I found myself with that public exposure. And for a long time, I fought against it and then one day I thought, well, why aren’t we using it and why aren’t we using it for something positive?
And that is how Inspiring Women first came up. And we managed to get 25,000 women all throughout the country going back to school. And then in 2016, I wanted to internationalise it. And to be honest, Matthew, I think that at that point some people thought, oh, well, you know, her husband is not in politics anymore. She's not going to be able to make it. And it is my pride, really, to say that that it was almost an immediate success.
We are now in 30 countries, and it's not because of me. It is because women, women really and people generally, everybody wants to help. If there is something easy they can do to help, of course they will. They just need to know how to do it. And to me, that is the journey of change.
In order to change things, you need to do two things. One is to be very focussed and I believe in the theory of the square centimetre. You just choose one square centimetre and you do not move away from that until you see change. And on the other hand, the second element is that it has to be simple. So, whenever you want to effect some change, you need to make a massive effort at the beginning to simplify the action.
And that, I think, is what we have successfully done in Inspiring Girls. It's very, very simple. What we are asking from every woman, go back to school one hour. You know, we have means for you to do it remotely, if you cannot do it physically, is a tiny, tiny thing that we are asking from you. But it has a multiplier effect on girls.
And remarkably, you know, that that work led up to the point in 2021 where you launched this kind of global campaign to connect women role models from all walks of life. The #thislittlegirlisme hashtag went viral. Thousands of women shared their stories. I'm just looking at some of the people, Madeleine Albright, Julia Gillard, Martina Navratilova. And what do you hope is the kind of lasting effect of a kind of amazing moment like that where you really did create a kind of global conversation?
Well, the reason we launched this little girl is me is that we are forever thinking, where are the girls? The issue is not finding the female role models. There are so many of them. The issue is how do we connect them to the girls? And in order to do that, we need to see where the girls are, so that we go there.
So initially we started saying, let's go back to school because they are there. And then it was like, well, let's make it even easier so that in parallel, let's try to have a video hub so that from their homes they can have access to their role models. And then it was, well, why do they have to click on the video hub? Can we just put the role models there in their feeds of social media so that even if they don't click, they have to see these female role models?
And that is why we thought of this campaign for bringing the female role models to the mobile telephones of the girls. And we did that with something really simple that every woman can do, which is to post a picture of themselves around International Day of the Girl and to say what they wanted to be at that time. You know, their journey, how they went up. And then I mean they those lessons in life about falling down and going back up again are really invaluable for the girls. And that is why we put together the campaign.
And what we want to do is to continue doing it year after year so that every International Day of the Girl in October, we do something more than just saying: “Happy International Day of the Girl”. We do something meaningful, which is very, very little effort.
But girls can see all those enormous amounts of female role models, women who are, you mentioned some Matthew, who are well known; the really impressive thing is the amount of women who are not well known who participated in the campaign. And those are the ones that girls normally cannot see and they were able to see them at that time.
Yeah, it's fantastic. Now, turning to this year's International Women's Day, the theme is embrace equity and the kind of talking point that I think that the architects of the day want to get people to focus on is this notion that equal opportunities are no longer enough.
What does that idea that equal opportunities are no longer enough? What does that mean to you, Miriam?
Well, I hope that I don’t surprise you, Matthew, by saying that sometimes I'm a little bit sceptical about these slogans that come out. It’s mostly from the UN around International Day of the Girl and International Women's Day. And I think that when we talk about equality and equity, there is a really good thought behind it, right? So, I think that the difference basically is we talk a lot about equal opportunities, but we need to make sure that we go one step further, which is to adapt those opportunities to whatever is the starting point of everybody. So if your wish is the customisation or personalisation of the equal opportunities that, no doubt in theory is a really, really good idea.
You know, last year it was breaking the boundaries. So again, it's concepts that make us think and that I am in favour of that, you know, let's think about how we can go to the next step.
The only issue that I have some times with some of these slogans is that they tend to be a little bit far away from reality. So right now, we do not have equal opportunities. Right now, we have equal opportunities in some countries before the law between men and women. In some countries, we don't even have equality before the law. We have in countries like ours, mine, Spain, yours, the UK, we have equality more or less in the workplace, though there are some final touches that are missing there. But by and large, all throughout the world there is not equality at home. Women continue being the ones that take the burden, not just of bringing up the children, but that, there have been some developments in the last few years, but by and large, they take care of the houses and organising everything that is necessary for families to survive.
While that is still happening, I think that it is great to have that reflection about equality versus equity, but I would like to see more action and more pressure from the UN and more focus on the public policies that are needed to get that basic equality that we still don't have.
That's really interesting, and there's an element that I want to come back to in a second, but just before we move away from some of the core issues around equality in the workplace.
In the NHS, we have 4 out of 5 of the workforce is female, but less than 50 per cent of board places are taken by women. So, there is still an issue about women, as it were, getting to the top. What more do you think needs to be done there? And also, you advised and sat on the board of large companies in terms of the area of equality and diversity, and I wonder what that's taught you about what organisations, of course the NHS one of the biggest organisations in the world, but what organisations need to do, what are the extra things they need to do, to make sure that the commitment to equality is real right up to that board level?
To me, the only thing that is missing for women to have more access to the top posts and the board, and sometimes it's not really the board in terms of non-executive posts, it’s mostly the executive posts. All that is needed is to look for the women. The women are there. The only issue is that not enough effort is being made to find those women and to allow them to apply for those jobs.
So, precisely because I have been in boards, I know the quality of people in boards. It is just not true that everybody who is on boards right now is absolutely outstanding. And that there is no mediocrity. And if suddenly you open this up to more women, the level would go down.
I can give names and family names of people who I have seen on boards and should not be there, as I'm sure that you can as well. Anybody who has been on boards has had that experience. So, the issue is just to find them and to make sure that they do have those opportunities.
I happen to come from a continental culture. We are a little bit more open to systems like quotas than you are in the Anglo-Saxon culture. I think that everybody has to find their way, but they are there. And I think that the main thing that one has to do is to make sure that financial rewards go together with the task that is given to anybody to find those women.
If you are asking your human resources department, if you are asking your search firm to find diversity and to find women for certain jobs and to find enough diversity for those jobs, they should not receive the same remuneration if they do not find them, because they are there.
And I think another element of this and it not just in relation to gender but other areas is the importance of mutual support. We have a health and care women leaders network that we run at the Confederation. And it's been a really powerful tool for change. In terms of, on the one hand, lobbying the NHS to be an exemplar for flexible working, eliminating the gender pay gap, but also just providing that mutual support for women on the journey up, but also women at the top who then still face some of the challenges that you've described.
And if I may, flexible working is not just for women.
No, of course. It's a very well made point.
But I just wanted to return to something you said earlier about how we might be achieving equality in elements of the workplace, but we don't have equality necessarily in the home.
There's another dimension to this, which is around class. Alison Woolf wrote a book about this a few years ago in which she talked about the fact that in many countries, including developing countries, there'd been really quite remarkable progress amongst middle class women in professions in relation to gender equality. But yet when you looked at the other end of the labour market, you looked at the lowest paid jobs, still women were overwhelmingly concentrated in some of the lowest paid lower status jobs.
Are you concerned that sometimes when we talk about these issues, we focus on the professional progress of women and we don't talk enough about the relationship between gender equality and economic inequality?
Well, you throw a lot of angles into that question. Do I think that there is a class issue? Yes, I do think that there is a class issue, of course, and there is an economic issue.
Very often, where you see most progress in countries in terms of equality is the middle class. Why? Because in the lower class you have a lot of women who simply cannot afford to work, in some cases, because they cannot afford childcare and in some other cases they cannot afford not to work. So, they don't have freedom to do any of those two things. They just have to go with the circumstances, frankly. And they are in survival mode. So, a lot of the progress and the changes that you see there tends to be in the middle class.
I think that at some point we all need to start talking about something that has become a bit of a taboo, which is what happens with the women of the upper classes. And I think that we would be surprised if we see the numbers, at the amount of women in the upper class who decide not to work and simply to support their husbands. And those are women who can afford childcare. Nevertheless, they are not, they have decided not to work and they choose for that family model of only one of the two can have a career. That is certainly something that I have seen around the city of London when I first came to the UK here 15 years ago. I have seen that in Silicon Valley. It is it is something that we haven't examined yet why that is happening.
But yes, certainly the bit that that worries me most is obviously what happens in the in the lower class jobs and the interaction with the middle class and that there is no doubt that you if you are a woman working in in a low pay job, you have very few options and you depend very much on everybody else for everything. The fact that we don't focus enough on childcare and options and there has been such little progress in public policies on making sure that we as a society, we provide options in terms of not just childcare, but we should be doing it also in terms of what is needed for families to be able to work if they so wish.
And frankly, from the point of view of public policy, you know, you can look at it from the point of view of the individual and there it is about choice. Anybody who wants to work, for example, should be able to do that if they so wish. But you can also look at it from the point of view of the society of the countries. And the interest of the countries is to have as many people in productive jobs as we can know. We can afford the welfare state for two reasons since the Second World War, because of that and because women have started working. So that is not going to stop, right? So, if we have an interest on that happening economically, we should be having the public policy discussions that open up to possible solutions and new options. And that really is not happening almost anywhere in the world.
No, it's very interesting and I suspect that childcare is going to be an issue of some prominence at our next general election. I think I think both the Conservative government and Labour opposition and I'm sure that Democrats as well are recognising that that what they say about their commitments around childcare will be will be listened to closely by the electorate.
But the other reason I wanted to talk about the relationship here between kind of economic power and gender is around care. So, we have big challenges in the National Health Service, but in many ways, a lot of health leaders would say to you that our challenges are less than the challenges facing our social care system, where we have, I don't know, 100,000, 170,000 vacancies. And many, many people in social care are paid at the minimum wage. They have pretty terrible working conditions. And I wonder whether, for you, one of the things we have to do is we have to change the way in which we understand care, the status that we give care in society, both care that is paid for, but also unpaid care, that crucial to a kind of building a more progressive, inclusive society is one which gives greater status and value to care. Do you agree with that?
I do agree with that. But not only because that is necessary to have a more progressive and inclusive society is because economically that is a discussion that we need to have.
We are clearly having an issue that we are not accounting properly for care and care costs and care value in our society. Whenever somebody does it for free within the families we kind of take it for granted, but then we do pay for care in some other cases. So, we should be able to put a value into that care and we should be able to see that, for example, for tax purposes. And we are not really examining any of that.
You know, in the last ten years, so to speak, the public policies generally have been at a standstill and we are not seeing kind of new innovative ideas to kind of move us where we should be going. We have all this economic revolution of a new society very much based in data and tech and all that, and we are not taking all that data and trying to see what new models of public policy we could have.
So, yes, I agree. I agree very much with that. You know, that is one of the points that I often make. You know, the care that the women give at home, for example. Why cannot we just put a value on it? Why has that become a taboo and why can't we just look at that on the tax and economic perspective? We just need somebody to start doing it.
And that is where I think that the big organisations, listen, a lot of the other things, you know the kind of societal changes we can do it, in charities and non-governmental organisations, they’re raising awareness. We can do it. A lot of the change can come from companies and public organisations, like the NHS as well. And you know we are all doing a lot of work in that respect, and we have made a lot of progress. But the public policy work that can only come from the public institutions or the international organisations like the UN. So, you need a lot of economic muscle and power to be able to do that work and that's where they should be focusing really. And that is where I would like to see UN women in particular focus.
Yes, absolutely. And just before we finish on this issue of care, I have one more question for you, Miriam. But on this issue of care, you quite rightly said to me earlier, flexible work is not just about women. Absolutely right. And one of the challenges is to get men to take up their entitlement to paternity leave or whatever entitlement there is that exists. And it seems to me that we talk a lot about automation, about AI. But one thing that is not going to be automated anytime soon is care. And as long as I think society understands care as a low status thing, then it has all sorts of other kind of consequences, not just about how do you recruit people to those jobs and how you value them, but also it means that something incredibly important like bringing up children or something incredibly important, like giving people comfort at the end of their lives that we don't take those things as seriously as we should as part of a good society.
So, I've got one last question, and I'm sorry if this seems a bit kind of pathetic, but nevertheless, I'm talking to you and I'm going to ask you. I'm a chief executive of an organisation and I'm committed to equity. Is there one thing you would advise me to think about when I think about what more I could be doing, myself, as a chief executive of an organisation?
The main advice that I will give to you is that whenever you set your equity objectives, you treat that as you treat anything else that you do as a CEO, as a chief executive, on anything else, any other objective that you put in your organisation, you tie the money to it. You put financial rewards and penalties to it. Those who meet the objectives, they get more money. Those who don't, they get less money. Treat your objectives on equity exactly in the same way.
Well, thank you very much for that advice. I will reflect on it. You're quite right. If you have objectives, you have targets and some of them you put incentives behind and rewards behind and others you don't, then people quite soon understand what that message is. Miriam González Durántez, it's been a real honour to speak to you. Thank you so much for giving us your time.
Thank you for having me. It has been a pleasure.